Go Figure: Murder or Accident?

David Healy, MD
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dr-harold-shipman-010Harold Shipman was a doctor in Britain who was arrested for murder in 1998. He turned out to be a true Angel of Death, the most prolific known serial killer, who killed — it is thought — between two and three hundred of his patients by prescribing opioids in large doses.

After his trial and conviction and jailing, he committed suicide in jail with no-one any the wiser as to why he had behaved the way he did.

His killing spree led to a change in medicine’s regulatory apparatus, ostensibly to ensure that this couldn’t happen again. Boxes were put in place, and mandatory courses on a range of issues from consent to continuing education. All of this takes time away from seeing people. But if Shipman’s case held any lesson it is that he was assiduous at ticking the boxes that registration bodies like the General Medical Council in Britain put in place. The system probably makes a future Shipman more rather than less likely.

Short of doctors who have been struck off for proven cases of negligent care or abuse of patients, we might all on average be safer with doctors the regulator is having problems with, who for the most part are more keen on seeing patients than spending time ticking boxes, rather than with the doctors who are in good standing with the regulator. But what can the system do? We, the public, won’t let it do nothing.

While Shipman’s killing spree with opiods was unfolding, North America was sinking into a prescription opioid epidemic that now accounts for 100 deaths per day, over 30,000 per year, over half a million since the epidemic began, perhaps the single greatest cause of death in America today.

The way in to the epidemic was laid during the 1980s with the marketing of Oxycontin by Purdue Pharma, supported by Abbott, and later Janssen pushing Fentanyl. There was an astute marketing of an idea – that people with real pain do not become addicted to opioids – a myth equivalent to the myth of lowered serotonin in depression. This was allied to new standards of care for pain management which hinged on RCTs, all of which demonstrated that opioids were effective – again exactly the same dynamic exploited by companies marketing SSRIs. The result was mass prescription of opioids by doctors, many of whom felt trapped between clinical wisdom and the risk of being sued. But clinical wisdom never makes it into guidelines or standards of care, and since standards of care emerged in the 1980s managers sack doctors who don’t stick to the guidelines – or refer them to their registration body.

Prescription-only status is another part of the regulatory apparatus. It was introduced in America in 1914 in response to escalating concerns about one of the first opioids — heroin.

Purdue’s marketing of Oxycontin exploited this deftly. Companies and doctors were in the clear provided all prescriptions were for physical conditions causing pain. Patients and doctors on cue, to a background tune being piped by Purdue and Janssen, engaged in a dance about the management of pain. There were no problems for doctors prescribing for pain, but if they had been prescribing the same drugs for addiction they would have been struck off.

Faced with the horrific consequences of this dance, the FDA intervened in extraordinary fashion two years ago. In 2014, a century after the introduction of prescription-only status, FDA made a potent opioid, naloxone, available over the counter in US states who were willing to endorse this option. Given intravenously or nasally, naloxone can save lives by reversing the effects of an overdose by other opioids.

To murder is human. To mass murder needs a regulatory apparatus. We have no problem viewing Shipman as a murderer. But what about Purdue or Janssen? And what about the role of regulators from FDA to the GMC?

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Adapted from DavidHealy.org

8 COMMENTS

  1. The local news paper has a front page story today, reprinted from The Washington Post. Headline: “Drugs intended for patients in the hands of illegal users. The story starts off telling how the DEA quietly targeted opiate & narcotic distributors, in an effort to “keep millions of pills out of the hands of abusers and dealers.” The DEA pretty much failed, as Joseph T. Rannazzisi, head of the DEA’s Office of Diversion Control from 2005 to 2015 admitted. He ADMITTED that the DEA FAILED! //// I’m at a loss for words. I don’t get it. Is GREED REALLY most of the answer for what seems to me to be a clearly broken system? We’re seeing “epidemic” levels of non-fatal, and FATAL opiate overdoses, even with “Narcan”, the opiate “antidote”. Of course, cost for Narcan has gone up several times it’s price a few years ago. Like several 100% “several times”. (Personally, I think we should just let the addicts die – but I’m also glad that my minority view doesn’t hold sway.) I can remember, back 20 – 30 years ago, when I was in the midst of my own prescribed psychiatric DRUG HELL…. I looked out at all you non-drugged “normal people”, and wondered if *I* could ever be “normal” again? Now, after 20 years “shrink proof”, I can only wonder, “My God, what is *WRONG* with YOU People….????…. How can you let this happen? I mean really, what’s WRONG with you people? God have mercy on us all…….. /~B./

  2. My former doctors believe opioids are “safe painkillers” and antidepressants are “safe smoking cessation meds.” They also do not know combining these drug classes results in one of the top ten most deadly drug interactions. They also believe the ADRs and common withdrawal effects of such a deadly drug interaction are “depression caused by self,” “paranoid schizophrenia,” and “bipolar.”

    “To [defame and] murder is human. To mass murder needs a regulatory apparatus.” And a “white wall of silence.” It’s a shame the FDA, APA, big Pharma, malpractice insurance companies, and AMA have turned today’s medical community into a bunch of unrepentant blasphemers, murderers, and thieves. I used to think doctors were intelligent and ethical. I guess I was “delusional” after all, and now I understand why, while suffering from a drug withdrawal induced super sensitivity manic psychosis, Jesus supposedly claimed “All the doctors are going to hell.”

    I still hope it’s not all of them, thanks for speaking out, Dr. Healy. It’s a shame more doctors are not as wise as you. “Murder or Accident?” Murder, and in my case, thank you Jesus, only attempted murders. Opioids and antidepressants are not “safe … meds,” they are dangerous, mind altering, addictive drugs. How embarrassing the majority of doctors today are not intelligent or ethical enough to confess to this reality.

  3. Interesting. I have read of the state of West Virginia, that there is a very high level of use of prescription pain killers, particularly Oxycontin. It is so severe that people are calling West Virginians “Pill Billies”.

    Now I am always skeptical when a stereotype about a region, like Appalachia, is being expanded. I have to wonder if West Virginia is really that much different from anywhere else in that region, or in the rest of the country.

    But I do take note of the issue though. We have been taught to see drug addiction as a problem centered among ethnic minorities and in major urban centers. But it seems though that this is often not even close to true. I read that either Oklahoma City or Fresno California are the methamphetamine capitals, and that it is mainly a white drug. What Oklahoma City and Fresno have in common is a great deal of economic dislocation in the last decade.

    And then we have been taught to see prescription medicines and street drugs as completely separate. But I don’t see it this way at all.

    Usually the medical profession has been opposed to any new forms of regulation. For one thing, this would lower the very high standing in which most people hold doctors, and hence lower the profession’s money earning potential.

    Now when people are dying, while in a doctor’s care, and seemingly from medicine overdoses, something does need to be done. Maybe some greater records keeping and oversight procedure, so you could see what people were being prescribed, and why, and in what dosages.

    That way, there could be some intervention when records are not being kept accurately, and before there is any pattern of harm.

    But as to the overall issue of using chemicals to alter mood, I oppose it. I am not saying that criminalization is the answer. But I think people need to be asked to really look at their logic.

    Recently on MIA:

    Saying that opioids interfere with some “parenting instinct”. Well what if there were not true, would they then be okay. And do we really want to be testing people over such things?

    Saying that LSD and psychedelics are more effective than psychotherapy. Well is that really the way we want to be looking at things?

    Giving detailed information about the effects of using benzos, but not taking a clear anti-drug position of any type, and not showing the fallacies involved in the purpose behind the drugs.

    My view is that in order to fight back, we have to reject all drugs and alcohol, and also escapist ideologies like evangelical religion and the recovery movement, and also psychotherapy.

    https://www.marxists.org/history/usa/workers/black-panthers/1970/dope.htm

    Nomadic

  4. When the Obama Administration gave large fines to various pharmaceutical companies for civil/criminal behavior, off-label marketing, and so on, for such drugs as Zyprexa, there were a number of people calling for criminal prosecution of the executives who made the decisions that lead to many deaths and permanent ruined health states of those given the drugs. Even the FDA made some noises about prosecuting pharma executives whose behavior resulted in death/disability.
    But absolutely nothing happened, nor has anything happened to the opioid-pushing companies. This is despite all evidence and good investigative journalism.
    So much for the “hopey changey” thing (as Sarah Palin would say).

  5. “ebl” – As much as I agree with what you’re saying here – and I’m really NOT trying to start an argument – I don’t think it’s really accurate to say “the Obama Administration gave large fines to various pharmaceutical companies for civil/criminal behavior…”…. It’s mostly career lawyers with the Justice Department. There are lots of Federal Gov’t employees, who were working for the FedGov before Obama, ands will still be there after he’s gone. Yes, lots of Agency heads left with Bush Jr., and Obama named replacements, who will leave after Obama goes…. For example, in 2014, Walgreens Co. paid an $80.Million fine, for letting there stores fill bogus opioite prescriptions. But, Walgreens did NOT admit either civil, *OR* criminal liability. HUH? Yeah. They paid an $80.Million fine, but didn’t admit civil or criminal liability. Don’t worry, “ebl”, it doesn’t make sense to me, either. But that’s how screwed up the Federal legal system is in these kinds of cases. The law is WIERD! What’s worse, to me, is that a small group of high-level Execs, CEO’s, etc., have gotten FILTHY RICH, and as you say, NONE have been indicted. That’s why I say PhRMA, and psychiatry, are a DRUG RACKET. And, it’s allowed to continue. I’m just one of it’s victims. What do *I* know? Sarah Palin was CORRECT! That “Hopey-Changey” thing was just more LIES, LIES, LIES…. Thank-you for your comment, my friend! (Several States, through their Attorneys General, have filed several lawsuits – most are still pending, as they drag on for years, and sometimes DECADES. It’s delay, delay, delay. And as we know, “Justice delayed is justice denied! Sad, very sad….

    • @”ebl”: I’m very sorry about you losing a family member to Zyprexa. As a victim of psychiatry myself, I can see NOW, how the entire “mental health system” is a huge “BLAME the VICTIM” system. A scapegoating system. A system which creates “black sheep”. So while it may be easy for *US* to see what needs to change, other people don’t see things that way. They WANT, and even NEED the system to be the way that it is. And there’s HUGE amounts of money being made, and spent, to keep the crooked system going. It employs a lot of people, and makes some of them filthy rich. I think we need to REALIZE this, UNDERSTAND this, and ACCEPT that this is how it *IS*. Not how it should be, or will be, just how it is now. And, I think we need to keep ourselves healthy and active, and not lose hope, or allow ourselves to fall into despair, or to give up. I like to write here, and I hope many, many people see what I’ve written. But when even *ONE* person sees what I’ve written, and replies with even a short comment, then I feel my time has been well-spent, and I have helped carry the message forward. Progress seems slow, and I find myself ALMOST wanting to give up sometimes. But I’m doing this for *ME*, my family, and all the OTHER FOLKS who have lost and suffered because of the greed, arrogance, and ignorance which ids modern psychiatry & the pharmaceutical-industrial complex…. THANK-YOU, “ebl”. Your family member is NOT forgotten…. ~B./